Addressing Vaccine Hesitancy
LAST MONTH, THE WORLD HEALTH ORGANIZATION CERTIFIED INDIA AND SOUTHEAST ASIA AS BEING
polio-free, an extraordinary achievement given that the polio vaccine was declared safe and
effective only 59 years ago. Vaccines are one of the safest and most cost-effective medical
interventions in history. By immunizing infants, children, and teenagers, vaccines protect
the entire community. Nevertheless, there is a surge of outbreaks in vaccine-preventable diseases in the United States. What research is needed to reverse this trend?
The crux of the problem is our inability to demonstrate to skeptical parents that vaccinations save lives. On the one hand, the United States has sustained impressive uptake rates
for vaccinations overall. During the 2012–2013 school year, the median coverage was about
Regardless of the source, the results are the same: debilitating infections, hospitalizations, and in tragic cases, death.
This frustrating reality illustrates that the facts do not always
speak for themselves. We need only look at Western Europe to see
how a few dozen cases of a vaccine-preventable disease can explode
into a countrywide epidemic: In 2007, France reported 40 measles
cases; in 2011, there were 15,000 cases with 6 deaths. In 2011, the
United States experienced its largest number of individual measles
cases (222) and outbreaks (17) since 1996. The source of nearly every
outbreak was someone who was intentionally unvaccinated—often
a U.S. resident traveling abroad or someone of unknown vaccine
status. 2013 saw the largest single measles outbreak (58 patients) in
the United States in nearly 20 years.
A recent report concluded that current public health communication about vaccines
may actually increase misperceptions or reduce vaccination intention, and that attempts
to increase concerns about communicable diseases or correct false claims about vaccines
may be counterproductive.* Research is needed to develop evidence-based strategies that
guide health care providers on how best to communicate the importance of immunization
to parents who are uncertain about what to believe. Last fall, an interdisciplinary group of
scientists, clinicians, and social scientists convened at the American Academy of Arts and
Sciences to discuss priorities in communication research that would provide specific solutions on how to move forward. The group’s conclusion (the report, for which we were
co-chairs, has just been released†) was that we need research that addresses how and when
attitudes and beliefs about vaccines are formed, how people make decisions about immunization, how best to present information about vaccines to hesitant parents, and how to identify communities at risk of vaccine-preventable disease outbreaks. A study of the 2008 San
Diego measles outbreak‡ found that the cost to the public health system of each measles
infection was $10, 376, whereas the total cost to contain the outbreak was $124,517. If the
type of research proposed by the American Academy report helps to prevent even a handful
of outbreaks, it will have more than paid for itself.
Strategies to combat antivaccine messages cannot be developed by educated guesswork.
Evidence-based approaches that facilitate vaccination are needed if we are to prevent dis-
eases that can easily be avoided and fulfill the potential of modern vaccine research.
– Barry R. Bloom, Edgar Marcuse, Seth Mnookin
Barry R. Bloom is a
professor at the Harvard
School of Public Health,
Boston, MA 02115.
www.sciencemag.org SCIENCE VOL 344 25 APRIL 2014
* http://pediatrics.aappublications.org/content/early/2014/02/25/peds.2013-2365. † www.amacad.org/vaccines.
‡D. E. Sugerman et al., Pediatrics 125, 747 (2010).
Edgar Marcuse is a
professor emeritus at
University of Washington
School of Medicine,
Seattle, WA 98195.
Seth Mnookin is an
assistant professor at
Institute of Technology,
Cambridge, MA 02139.